HomeMy WebLinkAboutStreet Cut Permits 9999 Norton Lane (2) 1700240 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 12/15/2017
GIS ID: 64809999 v r ti FEE: 50.00
MUNIS APPLICATION 4 201701807 EXPIRATION DATE:
1t h5 0
APPLICANT' ti LOCATION
NAME: CONNECTICUT WA DER COMPAlaiY ADDRia35 9999 NIJRTON DRIVE
ADDRESS: 25 NORTH ROAD F s OWNER ,` TOWN OF SOUTH WINDSOR
EAST WINDSOR,CT I��G08$ v' 1a�4U'S[JLLIVAN AVE
UK,CT 060742734
PHONE 860-623-3355 F
\h�IIc1DS
WORK DESCRIPTION: REIAIRyWA`I'I;IMA�NBREIK k
APPLICANT AGREES TO FURNISH THE TOWN OF sou TIIUINI�SOR THE AMOUNT OI?I ND REQUIRED AND TO REIMBURSE
IN
THE TOWN OF SOUTH WINDSOR FOR AN '- XPINSES:INCURRED;13'St THI;TOWIOR`1VIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND Ti APPI;ICAI�T I'IS FAMILIAR F VITH A1�TD WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN F,�Q TIC W1INDSOR=:S STREET CUT P;.ERMIT MANUAL.U
e
YV)D 1, (� \ ,� � ✓✓v
ISSUED BY D&R-IINS`PECTED INSPECTED BY
12/1 5/201 7 2:10PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
4'
l
f
W
2
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: L
LOCATION: CCKY)e Char)r) ko(-"�
TYPE OF WORK: Cf Aa%r m dk y L A jcc v- -
DATE INSP NEEDED: DATE INSP: a 11 r
INSPECTED BY: Ap
WORK IN ,
PROGRESS: Cr ��, 1 --- C`'`' - - ---
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES 0 NO
AS-BUILT: "
INPUT: c- DATE:
S/moiloy/farms 2014 Town of South Windsor IMPSECTION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00
Name of Firm CT Water Company Phone No. 860 - 622 - 9562
Address of Firm P.O Box 857 Fast Windsor (25 North Rd) Zip Code
Location of proposed work ('nrnPr of C:harinq Rd and Nnrtan La
Describe fully nature of permit requested Repair water main break.
Starting date 12/20/17 Call Before You Dig No
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway,No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$0
/sf
Est. Patch Cost$
Est.Curb Replacement ft
Est. Curb Unit Price$ /ft
Est.Curb Cost$
Est.Sidewalk Replacement sf
Est.Sidewalk Unit Price
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( ) Cash ( )Check#F
Applicant is responsible for contacting the Police Dept.and C.B.Y.D
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Paid By
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF SOUTH
WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND
THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WINDSOR'S STRTET/CUT PERMIT MANUAL.
Signed: �/ Print Name —=�.'# Date: 02
Street Excava' n Permit 2014
s
l
. 3
I 27
'-- 250 {
lI
�`• 272
RR
297 a ... - t 43
�C;,• 249
u�
M1 �53
L
200 A '` +
r f' + i 736
s4f00
... ....... f ;, ,.
--....._..- -----....... ......... .
si